Zygomatic & Pterygoid Implants

Rehabilitation of Atrophic Jaws

About Noris Medical

ENGINEERED FOR HEALTH The collaboration between leading experts and our team of experienced physicians and professional engineers to design, develop and manufacture innovative products and systems results in a creative synergy that benefits both the dental industry and the patients it serves.

Improving the lives of dentists and patients around the world with the leading technology in dental implant systems

GROUNDBREAKING RESEARCH & DEVELOPMENT Results in innovative solutions backed by clinical evidence. Each new product and system developed is supplied with comprehensive peripheral tooling needed for its successful implementation.

PROFESSIONAL TRAINING Familiarizes dental surgeons and technicians with expert techniques and tools.

PROVEN PRODUCTS & WIDE RANGE OF SOLUTIONS Enables all procedures, from simple to complex, to be tackled with ease.

PERIPHERAL TOOLKITS Enable easy implementation, providing a total solution which covers every step of the process.

ONGOING SUPPORT Ensures dental professionals benefit from knowledge sharing and backup every step of the way.

Table of Contents

Restoration of Atrophic Jaws 2-3

Zygomatic Implants 4-5

Zygomatic Surgical Kit 6-7

PteryFit Implants 8

Pterygoid Implant Tools 9

Multi-Unit | Straight & Angulated 10-11

Multi-Unit Components 12

Multi-Unit Drivers 13

Multi Unit Protocol 14-15

Clinical Cases

1- Zygomatic Implants for the Extra Maxillary Approach 16-22

2- Pterygoid Implants for Posterior Maxilla Rehabilitation 23-24

3- EZgoma - Zygomatic Guided Surgery: “Inverted Supports” Zygomatic Guided System 25-29

Pages

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Z

Z

P

P

Restoration of Atrophic Jaws

Implant prosthetic platform is shifted buccally to a more appropriate position of the restoration.

Angulated Multi-Unit abutment will provides the angle correction needed.

Multi-Unit SystemM

The pterygoid implant procedure provides posterior bone support without sinus augmentation or supplemental bone grafts, while eliminating the need for prosthetic cantilevering.

PteryFit ImplantsP

Pterygoid Implant Tools

Specially designed osteotomes for Pterygoid implants.

EZplan Pre-Op Preparation & Planning Assessment using specialized software

The Zygomatic implant placement is a highly predictable procedure with a high success rate in restoration of atrophic jaws, without the need for complex bone augmentation procedures.

Zygomatic ImplantsZ

Zygomatic Surgical Kit

Zygomatic surgical kit, designed for placement of zygomatic implants according to the Extra Maxillary approach.

M

MM

M

M

EZgoma Guided Surgery 3D printed guide enables safe and accurate placement

/ 4 / / 5 /

Zygomatic Implant

The Zygomatic implant is placed following the extramaxillary protocol. The implant is anchored in the zygomatic bone; the resulting torque is very high. A bypass of the maxillary sinus prevents damage to the sinus membrane.

The Zygomatic Implant is designed to provide a solution for cases of atrophic maxilla. The shape of the Zygomatic Implant consists of sharp threads at the apical part for maximum retention to the Zygomatic bone. The implant has a 2.42mm internal hex. connection, which enables simple and easy restoration. The Zygomatic Implant is available in a variety of lengths, from 30mm to 60mm.

Material: Titanium (Ti6Al4V ELI) Treatment: RBM

12.5

mm

Length

3.75mm

3.5mm

4.2mm2.42mm0Diameter Length Item

4.2 mm

30.0 mm NM-F4430

32.5 mm NM-F4432

35.0 mm NM-F4435

37.5 mm NM-F4437

40.0 mm NM-F4440

42.5 mm NM-F4442

45.0 mm NM-F4445

47.5 mm NM-F4447

50.0 mm NM-F4450

52.5 mm NM-F4452

55.0 mm NM-F4455

57.5 mm NM-F4457

60.0 mm NM-F4460

Cover screw included with all implants Item NM-S5023

Especially designed for the extramaxillary approach

RBM treated surface at the threaded part increases the BIC

2.42mm internal hex. connection

Available in lengths from 30mm to 60mm with 2.5mm increments

Smooth body to reduce periopathogens adherence

Deep threads for excellent stability in the zygomatic bone

/ 6 / / 7 /

Drilling Depth (mm)

605550454035

Depth Probe NM-X1028

0 Diameter Length Item

4.2 mm 30 mm

Fine Grit NM-D7201

Medium Grit NM-D7202

Coarse Grit NM-D7203

Zygomatic Burs for Groove Preparation

Zygomatic Step Drills0 Diameter Length Drill No. Item

2.0 mm

40 mm

1NM-D7520

60 mm NM-D7020

80 mm NM-D7120

2.8 mm

40 mm

2NM-D7528

60 mm NM-D7028

80 mm NM-D7128

3.2 mm

40 mm

3NM-D7532

60 mm NM-D7032

80 mm NM-D7132

L

Zygomatic Surgical Kit NM-X2118

60

55

50

45

40

35

30

60

55

50

45

40

35

1

60

55

50

45

40

35

2

60

55

50

45

40

35

3

16

ø2.8ø2.8ø2.8ø2

ø3.2ø3.2ø3ø3

ø2.5

ø4.2ø4.2ø4.2ø4.2

D4 D3 D2 D1Bone Type

8

4

0

60

55

50

45

40

35

3

1 2 33

Drill Sequence

Zygomatic surgical kit designed for placement of zygomatic implants according to the Extra Maxillary approach.

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Pterygoid Implant ToolsOsteotomes0 Diameter Item

2.0 mm NM-X3001

3.0 mm NM-X3002

Long Drills0 Diameter Item Length

2.3 mm NM-D7423 43 mm

2.8 mm NM-D7428 43 mm

3.2 mm NM-D7432 43 mm

3.65 mm NM-D7436 43 mm

2522201816

Depth Groove (mm)

16 18 20 22 2516 18 20 22 25

5m

m

Length

3.75mm

2.5mm

4.2mm2.42mm

0 Diameter Length Item

4.2 mm

18 mm NMAF4218

20 mm NMAF4220

22 mm NMAF4222

25 mm NMAF4225

Cover screw included with all implants Item NM-S5023

PteryFit Implant

PteryFit implants are installed in the posterior region of the atrophic Maxilla and are located in the Pterygomaxillary region.

PteryFit implants have been uniquely designed to match the anatomy of the bone structure. The lower V-shaped thread zone enables self-tapping. The middle zone square type thread is used for compressing cancellous bone and help achieving maximum BIC.

The smooth “Neck” surface at the top helps in eliminating the adherence of Perio-Pathogens, thus reducing the chances of an inflammatory process to develop around the neck area. The RBM treated surface increases the BIC.

Material: Titanium (Ti6Al4V ELI) Treatment: RBM

Lase

r Mar

k

Col

or C

ode

25222018151311.5

Depth Groove (mm)

3.2

Length

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Multi Unit Abutment

A710X

3.75

4.9

L1

2.0

Straight L (mm)

1

NM-A7101

2

NM-A7102

3

NM-A7103

4

NM-A7104

5

NM-A7105

NM-X7100Included with all multi-unit bases

Angulated 17 °

Angulated 30°

Angulated 45°

Angulated 52°

Angulated 60° L (mm)

2

NM-A7112

3

NM-A7113 NM-A7133

4

NM-A7134 NM-A7144

5

NM-A7152 NM-A7160

Included with all multi-unit bases

NM-S7101 NM-X7101Recommendation: Tighten the screw at a torque of 20 Ncm.Recommendation: Tighten the

base at a torque of 25 Ncm.

3.75

a

Multi Unit BaseA711X

L1

2.42

60°45°

30°0°52°

17°

Entire Product Line for Immediate Loading

Multi-Unit | Straight & Angulated

The Multi-Unit system provides a solution for screw-retained prostheses even with complicated-to-restore implants (for example, multiple tilted implants).

The Multi-Unit system comprises a full range of sizes for both the upper and lower jaws. Straight, 17°, 30°, 45°, 52° and 60° adaptors, in a variety of heights, connects to a wide range of complementary products.

Material: Titanium (Ti6Al4V ELI)

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Passive Fit Castable Abutment Kit

Universal AbutmentØ 4.9mm H 12mm

NM-T7121

Castable SleeveØ 4.9mm H 10.5mm

NM-C7120

Castable Sleeve PositionerØ 4.9mm H 10mm

NM-T7122

Screw*

NM-S7102

The Passive Fit Castable Abutment Kit consists of three parts aimed for the fabrication of accurate metal reinforced prostheses.

The Castable Sleeve Positioner is used for locating the Castable Sleeve on the plaster model, ensuring passive fit of the fabricated metal cast when cemented to the Titanium Abutments.

* Recommendation: Tighten the screw at a torque of 15 Ncm.

Healing Cap

Healing CapØ 4.9mm H 4.8mm

NM-H7101

Healing CapØ 4.9mm H 7.0mm

NM-H7102

Screw

NM-S7102Included with all healing caps above & available separately

Transfers & Analog

Open TrayØ 4.9mm H 11mm

NM-T7111

ScrewL 13mm

NM-S7111

Included with the transfer above & available separately

Plastic CapØ 4.9mm H 11mm

NM-T4402

2 m

m

Closed TrayØ 4.9mm H 8mm

NM-T7102

Screw

NM-S7102Included with the transfer above & available separately

AnalogØ 4.9mm

NM-T7151

Abutments

Ø 3.3 mm

Universal AbutmentØ 4.9mm H 12mm

NM-T7121

Ø 3.8 mm

Wide Universal AbutmentØ 4.9mm H 12mm

NM-T7123

Castable AbutmentØ 4.9mm H 12mm

NM-C7121

Screw*

NM-S7102Included with all abutments above & available separately

Titanium Base

Ø 4.9mm H 4.5mm

NM-C7124

Screw*

NM-S7102Included with the titanium base above & available separately

Multi-Unit Drivers

* Recommendation: Tighten the screw at a torque of 15 Ncm.

* Recommendation: Tighten the screw at a torque of 15 Ncm.

Straight Multi-Unit Drivers

Short Driver 2.0mm L 6mm

NM-X1016

Long Driver 2.0mm L 10mm

NM-X1017

Straight Multi-Unit Motor Mounts

Short Motor Mount 2.0mm L 20mm

NM-X1120

Long Motor Mount 2.0mm L 25mm

NM-X1125

Star Hex. Drivers

Star Hex. Driver 1.25mm L 7mm

NM-X7006

Star Hex. Driver 1.25mm L 14mm

NM-X7007

Star Hex. Driver 1.25mm L 20mm

NM-X7011

Star Hex. Motor Mounts

Motor Mount 1.25mm L 20mm

NM-X7008

Motor Mount 1.25mm L 25mm

NM-X7009

Motor Mount 1.25mm L 35mm

NM-X7010

Scan Bodies

Ø 4.9mm H 7mm

NM-C9207

Ø 4.9mm H 10mm

NM-C9210

Ø 4.9mm H 13mm

NM-C9213

Screw

NM-S7102Included with all scan bodies above & available separately

Multi-Unit Components

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Assembly of a Straight Multi-Unit Base

Assembly of Angled Multi-Unit Base

Immediate Loading(Fabrication of the temporary bridge)

Laboratory Phase Passive Fit Castable Abutment Kit

Impression

Choose the desired impression technique:

Healing Cap Assembly

1

2

1 1 1

22

33

4

Adjust the straight Multi-Unit Base to the implant by using the plastic handle.

Adjust the Multi-Unit base to the appropriate angle.

Use the handle as an indicator for the final screw emergence.

Assemble the Titanium Sleeve on the Multi-Unit base and tighten the screw at 15 Ncm.

Mount the Plastic Sleeve on the Multi-Unit analog and tighten with the screw.

3

Carve the Sleeves to the desired shape.

2

Splint the sleeves.

4

Cast the metal frame of the prosthesis.

Attach the pre-prepared provisional acrylic prosthesis.

For closed tray choose Snap-On-Transfer.

For open tray technique choose conventional Transfer.

Remove the handle.

Tighten the base at 25 Ncm, with a 2.0mm Straight Multi-Unit Driver.

Remove the handle by unscrewing it out.

The Passive Fit Castable Abutment Kit consists of three parts aimed for the fabrication of accurate metal reinforced prostheses. The uniquely designed Castable Sleeve Positioner is used for locating the Castable Sleeve on the plaster model, ensuring passive fit of the fabricated metal cast when cemented to the Titanium Abutments.

Use the Angulated Guide Pin to choose the right correction angle.

Tighten the base at 20 Ncm, with a 1.25mm Hex Driver or a Star Driver.

or

°17 °30

°30

°45 °52 °60

Multi-Unit Protocol

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Courtesy of Dr. Balan Igal D.M.D

Prosthetic rehabilitation of the upper jaw, after major bone resorption, is very challenging from both surgical and prosthetic points of view. The absence of teeth leads to cessation of the stimulation of the alveolar bone. The stimulation is caused by the physiological load which is transferred to the alveolar bone and prevents resorption.

Shortly after the teeth extraction the process of alveolar bone resorption starts. The ongoing resorption is progressively continuing over the years until reaching atrophy. Installation of dental implants at this stage, using conventional techniques, is very difficult due to extensive bone resorption and the accompanied pneumatization of the maxillary sinuses.

The conventional treatment options for these patients are mostly augmentation procedures, which are meant to increase the volume of the load bearing bone.

The bone for the augmentation is taken from different sources, such as: the iliac crest, or intraoral origin, like the mandibular ramus, the intermental region etc. Augmentation procedures are very complicated and require a long recovery period.

An additional treatment option for atrophic maxilla is the placement of Zygomatic implants.

The Zygomatic bone was found to be suitable for installation of dental implants. In 1998 Branemark presented the Zygomatic implant as an optional

solution for the treatment of oncologic patients. This solution was expanded later on to Atrophic Maxilla. Long implants were found to be a good alternative for complicated augmentations procedures. Even though they are not easy to install, they present promising outcomes (1, 2, 3).

Noris Medical Zygomatic Implant was especially designed for implantation in the Extramaxillary approach. The Extramaxillary approach enables the positioning of the prosthetic connection on the Alveolar Ridge, unlike the other methods in which the prosthetic unit is more palatinially positioned (4). This location is more correct and easier for the rehabilitation process.

In the Extramaxillary approach, the implant’s stability is being achieved only by the Zygomatic bone. For this reason the implant is designed with a spiral and deep retentive thread shape at its apex, while the rest of the implant is smooth. The diameter of all the Zygomatic Implants is 4.2mm and their lengths vary between 35mm and 57.5mm.

Prosthetic Rehabilitation of Atropic Maxilla Using 4 Zygomatic Implants Case Description

Courtesy of Dr. Balan Igal D.M.D.

68 years old female patient

Medical history:

• Controlled high blood pressure;

• Balanced Type II diabetes;

• Bilateral mastectomy in 2008;

Clinical and radiological findings:

• Combination Syndrome;

• Pneumatization of the Maxillary Sinuses;

• Severe resorption of the upper alveolar ridge;

• Perimplantitis and mucositis around implant in position of tooth 31.

Treatment PlanAfter radiological and CT assessments it was decided to install two Tubero Pterygoid Palatine Implants, 4 Zygomatic implants at the Extramaxillary approach and one implant in the incisive canal.

The surgical procedure was done in the Split Mouth technique, in order to reduce the exposure time of the bone.

After the installation of the implants, augmentation was done, using Calcium Sulfate + HA.

Correction of angulation was achieved by using Multi-Units in angulation of 17°, 30°, 45° as found necessary.

In the lower jaw, the removable prosthesis was changed to fixed prosthesis, on Multi-Unit bases, as well. Rehabilitation was performed on the day of the surgical procedure.

A few hours after the operation, the patient received two provisional acrylic bridges reinforced by induction welded Titanium (grade 5) bar.

Clinical Case 1Zygomatic Implants for the Extra Maxillary Approach

/ 18 / / 19 /

Panoramic and CT illustrate the Pneumatization of the Maxillary Sinuses and the Severe Resorption of the upper Alveolar Ridge (Figs 1, 2)

Combination Syndrome

Groove preparation for leading the Zygomatic Implant drill

The integrity of the Schneiderian Membrane can be observed (Figs 5, 6)

5

Zygomatic Implant in situ

1 4

2

3

Upper Jaw

6 7

Clinical Case 1 (Cont.)Zygomatic Implants for the Extra Maxillary Approach

/ 20 / / 21 /

Correcting the Angulation using a 45° Multi-Unit Abutment

8

10

The surgical procedure was done by Split Mouth technique in order to reduce the exposure time of the bone during the installation of the Zygomatic Implants. Two Implants were placed on each side (Figs 9. 10)

9

After the installation of the implants, augmentation was done using Calcium Sulfate + HA

11

Transfers were mounted and fixed on the Multi-Units in order to take an impression using the Open Tray technique but the impression was taken without using a tray (Figs 12, 13, 14)

12 13

Upper jaw provisional Acrylic Bridge reinforced by induction welded Titanium (grade 5) bar

14 15

16 17

Impressions of the lower jaw using Snap-On Transfers

Clinical Case 1 (Cont.)Zygomatic Implants for the Extra Maxillary Approach

/ 22 / / 23 /

18

Lower jaw provisional acrylic bridge reinforced by induction-welded Titanium (grade 5) bar

19

20 21

In the upper jaw, two Tubero Pterygoid Palatine Implants, four Zygomatic implants at the Extramaxillary approach and one implant in the incisive canal were installed

10 months Post Op with the final restoration

22 23

Clinical Case 1 (Cont.)Zygomatic Implants for the Extra Maxillary Approach

Pre Op Panoramic X-ray Osteotome Ø2.0

1 2

Osteotome Ø3.0

Implant installation — the torque of the implant is above 35Ncm in order to enable immediate loading of the implant

Drill sequence Ø2.3 (NM-D7423), Ø2.8 (NM-D7428)according to bone type

Pterygoid implant

3 4

5 6

Clinical Case 2

Pterygoid implants for Posterior Maxilla Rehabilitation Courtesy of Dr. Balan Igal D.M.D

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Implant holder is removed Multi Unit assembly

7 8

Post Op panoramic X-raySnap-on Transfer for Multi Unit

9 10

Clinical Case 2 (Cont.)Pterygoid implants for Posterior Maxilla Rehabilitation Courtesy of Dr. Balan Igal D.M.D

/ 25 /

Clinical Case 3

EZgoma - Zygomatic Guided Surgery

/ 26 / / 27 /

Pre Op X-ray

1

Attaching the guide in position

Digital Planning

Attaching the guide in position

2

3 4

Fixing the guide Preparing the osteotomy for Pterygoid implant

5 6

Insertion of PteryFit implantPteryFit implant

2mm drilling with a sleeve support (blue)Preparing the osteotomy for Zygomatic implant Groove preparation

7 8

9 10

Clinical Case 3 - Guided System

“Inverted Supports” Zygomatic Guided System Courtesy of Dr. Lederman Shlomi D.M.D O.M.F.S

/ 28 / / 29 /

Drilling Measuring Implant length

11 12

Inserting the Implant

Placing Multi Units

Zygomatic Implant

Placing Multi Units

13 14

15 16

Removing the Guide Transfers on the Multi Units

17 18

Post Op X-RaySuturing

19 20

Clinical Case 3 - Guided System (Cont.)“Inverted Supports” Zygomatic Guided System Courtesy of Dr. Lederman Shlomi D.M.D O.M.F.S

Notes

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